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p4q�1k SAN JOAQUIN COU Y <br /> 'y ENVIRONMENTAL HEALTH DEPARTMENT <br /> P: .1 <br /> 1868 East Hazelton Avenue. Stockton.. CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> �/FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n C dt . Z Date: <br /> Address: C City: Zip Code: <br /> Owner/Operator: '66�Y1'ltil L Telephone: <br /> Program Element: I Lo�� Program Record: C v I , Inspection Type: <br /> S6180 Posted ❑Yes ❑ Rermit Posted Yes r' I Re-Inspection on or After: <br /> OBSERVATIONS AND CO ECT! ACTIONS <br /> 013 M L2 Lin arlA <br /> AIQOY- in i CDVWLa -zan+ ckl <br /> n V,3 OY o >V-7 Go <br /> m intc,4L (p -9 -!e ro r (40 OtrnL)ri A t a i✓V1 -J Peo <br /> s h� Yn.%�d d f -1-i► ��I- s <br /> h r <br /> 0 <br /> q r p W n Lo A2 <br /> c�a Z C-tcA <br /> L r ' <br /> IV yl,p — <br /> W A Y`2 _ C7 t'_ �- 1�t GO Y)�-O �l✓1-,' _pvL-� ��'Lt� .— �'1-2- <br /> _ 56-41 cA <br /> � r , <br /> n�-�- <br /> 4- r - <br /> r <br /> nq, <br /> IJV Y !4- (— <br /> c,t� <br /> law <br /> at . turd <br /> Food Safety Certification ( Facility Hot Water Temperature Warewashing <br /> Name: 'Hand Sink: F 'Chlorine: ppm ;Heat: F <br /> Exp.Date. arewashing Sink: of Quat.Amm.: ppin Other: F <br /> Received By I Title: <br /> EH Specialist: ' Phone: 0,5 3_ r? ' <br /> Time in: Time Out: Page'of <br /> EHD 16-24(2^d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />